动静脉畸形（ppt）课件

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1、ArteriovenousmalformationofthebrainDiagnosisandtreatmentDevelopment3rdweekofpregnancyprimitivevesselsdonotdevelopintonormalvasculatureformationofanarteriovenousshuntSymptomsHemorrhagehistoryofsuddenheadacheageusually25–35yearshemorrhagelessseverethanSAHnovasospasmrisk2–3%peryearSeizureso

2、ftenfocal,butmaygeneralizeoftenbetterafteroperationNeurologicaldeficitduetoischaemiaofsurroundingbraindevelopswithincreasingageespeciallyinlargeAVM’sDiagnosishistoryandneurologicalexaminationCT-scanMRIandMRAangiographyEvaluationsizedrainingveins(deep)arterialfeederslocalizationinbrainass

3、ociatedaneurysmsdefinebleedingsourceTreatmentconservativeclosingoffeederarteriesexcisionendovascularradiotherapyConservativetreatmentcontrolofepilepsycontrolofhypertensionlife-styleadviceClosingfeederarteriesreductioninbloodflowshortlivedeffectcollateralswilldevelopnoriskreduction!Excisi

4、onsizelocalisationnumberoffeedersvenousdrainage±75%canbeexcisedonly100%effectivetreatment!dependsonEndovascularballoonocclusionocclusionofthenidusidentifybleedingsourceonlyindicatedif100%eliminationmaybecombinedwithsurgicaltreatmentRadiotherapycauseshyperplasiaofintimasecondarythrombosis

5、fordeep-seatedAVM’s<3cmocclusionrate80%effectaftertwoyearslife-longfollow-upnecessary?OperativetechniqueBP<100mmHgmoderatecoolingstartonthearterialside!observenaturalshapeofAVMocclusionofveinsaslaststepkeepBPlowpostop.keeppatientsedated24–48hoursProblemsoedemaseizuresperfusionpressurebre

6、akthroughre-bleed(onlyifexcisionincomplete!)Example#1Example#2Whattodo?